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Author: admin | 30.09.2014 | Category: Ringing In The Ears Causes

External Auditory Canal Otitis Externa Defenses include cerumen which acidifies the canal and suppresses bacterial growth. External Auditory Canal Otitis Externa Cerumen prevents water from remaining in canal and causing maceration. External Auditory Canal Otitis Externa-Management Topical antibacterial drops such as Neomycin otic, polymyxin, Quinolone otic Otic steroid drops containing polymyxin-neomycin and a topical corticosteroid.
External Auditory Canal Chronic Otitis Externa Duration of infection greater than four weeks, or greater than 4 episodes a year Risks: inadequate treatment of otitis externa, persistent trauma, inflammation or malignant otitis externa. External Auditory Canal Malignant Otitis Externa Inflammation and damage of the bones and cartilage of the base of the skull Occurs primarily in immunocompromised Most common etiology is pseudomonas aeruginosa.
External Auditory Canal Malignant Otitis Externa Need IV antibiotics Might need surgical debridement. External Auditory Canal Cerumen Impaction Cerumen is produced by apocrine and sebaceous glands in external ear canal. External Auditory Canal Foreign body Can include toys, beads, nails, vegetables or insects. External Auditory Canal Foreign body- Management Irrigation is best provided the TM is not perforated Destroy insect with lidocaine or mineral oil. Tympanic Membrane Bullous Myringitis Vesicles develop on the TM second to viral infections or bacterial infection Usually associated with middle-ear infection May extend into canal. Middle Ear Acute Otitis Media Viral respiratory infections cause inflammation of ET When ET is blocked, fluid collects in the middle ear. Rehabilitation therapy is proved to be effective in reducing disability in patients with persistent symptoms of disequilibrium after acute unilateral peripheral vestibular deficit.
Unilateral peripheral vestibular deficit is one of the most frequent disorders affecting the equilibrium system. In reducing disability caused by peripheral vestibular lesions, rehabilitation is proved to be an effective method by facilitating central nervous system compensation [2-4]. Among the mechanisms that contribute to the recovery of vestibular responses, vestibular adaptation plays an important role, owing to the plasticity of the vestibular system. We enrolled in the study 28 patients (20 women, 8 men; mean age, 59 + 6 years) from 1 to 6 months after the acute phase of unilateral vestibular deficit. We randomly assigned patients to two different treatment groups: Group 1 patients received VES, whereas group 2 patients were assigned to rehabilitation via the performance of oculomotor exercises. The DHI is a standardized assessment of functional performance for vertiginous patients [17].
We performed static posturography with patients standing on a stable force plate sensitive to vertical force. We also tested the patients on foam rubber pads with eyes opened and closed (pad EO, pad EC) so as to have information on the cybernetic ratios existing between the three subsystems: visual (Vis), vestibular (Vest), and somatosensory (Som).
The therapeutic protocol used for both groups consisted of daily 40-minute sessions for 10 days with specially trained physical therapists.
For patients in group 1, we placed surface electrodes on the paravertebral nuchal muscles opposite the impaired vestibular side.
We tested for differences between the DHI test values and the performance on posturography using analysis of variance ( t-test) in each group before and after treatment.
After discharge of patients from therapy, verbal reports from all the subjects indicated a reduction of their symptoms.
At static posturography, group 1 patients showed a reduction of length, surface, and LSF in all the conditions.
Analysis of the components-visual, vestibular, and somatosensory-of the equilibrium system did not show any significant variation (Fig. Rehabilitation facilitates the recovery of patients with peripheral vestibular lesions as demonstrated by literature since 1940.
Rehabilitation of patients affected by unilateral peripheral vestibular disorders and treated with oculomotor exercises without head movements 1-6 months after the onset of the deficit resulted in both reduced subjective reports of disequilibrium and improved balance.
Also, stability, as evaluated with static posturography, improved significantly after oculomotor rehabilitation in the EO condition as regards both length and the LSF.


The results obtained with the oculomotor exercises are not unlike those derived from the employment of VES. A comparison of the two rehabilitative methods revealed no significant difference between them (as emerged from a statistical analysis), revealing that both are effective for affected patients.
Oculomotor exercises employed in most rehabilitative protocols, together with head movements to improve vestibular adaptation, have proved to reduce both the perceived overall impairment and postural sway in patients with recent unilateral vestibular disorders, even though such disorders are not associated with head movements. Conductive hearing loss URI symptoms Vomiting, diarrhea Fever TM bulging and erythematous with decreased or poor light reflex. A Comparison Between Oculomotor Rehabilitation and Vestibular Electrical Stimulation in Unilateral Peripheral Vestibular Deficit. The aim of this study was to evaluate the effects of oculomotor rehabilitation (group 2) on static balance and a dizziness handicap and to compare those with the effects to vestibular electrical stimulation (group 1).
Although clinical experience suggests that, after the acute phase, recovery of gaze and postural stability often is possible without specific exercises, some patients have a prolonged recovery period, do not return to all normal activities, or continue to have subjective symptoms of disequilibrium [1]. Goals of rehabilitation are, therefore, the reduction of the severity of the symptoms and the improvement of functional balance, physical mobility, and overall activity level. Most of the exercises used in vestibular rehabilitation protocols aim to improve this mechanism by inducing retinal slip during head movements [10]. All had received only pharmacological treatment during the early stage of disease, had already returned to normal activity, and were complaining of persistent disequilibrium. All patients completed the dizziness handicap inventory short form (DHI) [16] and were tested with static posturography before and after the rehabilitation program. The short form-in which the 25-item, three-level DHI has been reduced to a 13-item, two-level form-was chosen because patients can respond to it more quickly. The stabilometric platform used for this study was a force plate mounted on three strain-gauge force transducers positioned at the vertices of an equilateral triangle, providing description of body sway in terms of displacement of patients' center of pressure [Standard Vesibology Platform (SVeP) 3.5 system, Amplifon, Milan, Italy]. The stimulus was a biphasic asymmetrical modulated square wave with a pulse width of 100 µsec and a stimulation frequency of 80 Hz.
In sinusoidal pursuit, patients' eyes had to follow a target moving across the projection screen with constant velocity (20 degrees per second and 40 degrees per second), first horizontally and then vertically. Dizziness Handicap Inventory score before (T0) and after (T1) treatment in group 1 (vestibular electrical stimulation) and group 2 (oculomotor exercises). Only four patients in group 1 and two patients in group 2 reported the same score as was reported before therapy.
Comparison of Standard Vesibology Platform (Amplifon) length, surface, and length-surface function (LSF) values before (T0) and after (T1) treatment in group 1 (vestibular electrical stimulation). Comparison of Standard Vesibology Platform (Amplifon) length, surface, and length-surface function (LSF) values before (T0) and after (T1) treatment in group 2 (oculomotor exercises). Modifications of equilibrium system components [visual (vis), somatosensory (som), and vestibular (vest)] before and after treatment. Most rehabilitative protocols employ exercises that improve either vestibular adaptation or sensory substitution with eye-head coordination and balance retraining exercises in static and dynamic conditions. After discharge from therapy consisting of 10 rehabilitative sessions, developed under the guidance of specially trained physical therapists, these patients' DHI scores showed significant improvement, suggesting that patients felt more confident in everyday life. We have used this technique since 1985 in patients with unilateral vestibular diseases, and it has proved to reduce the period of disability after a vestibular deficit.
However, the two techniques are supposedly acting on different components of the equilibrium system: Studying the three components-visual, vestibular, and somatosensory- with static posturography added using foam rubber pads, we noticed that in patients treated with VES therapy, the vestibular component had minimally increased after the treatment sessions, whereas in those treated with oculomotor exercises, the somatosensory component was improved at the end of the rehabilitation sessions.
Before and after therapy, we tested 28 patients, using static posturography and the dizziness handicap inventory short form.
VES is a noninvasive technique that provides nerve or muscle stimulation (or both) via surface electrodes placed on the paravertebral nuchal muscles opposite the impaired vestibular side. The diagnostic protocol included clinical examination, posturography, videonystagmography, and rotatory chair and caloric tests that demonstrated a canal paresis of at least 25%. The retained items explore the domains of eye-head movements, full-body activities, and mood alteration as the DHI scale. In reading exercises, we asked patients to read paragraphs from a paper being moved by the therapist from one side to another, up and down, forward and backward.


Nevertheless, an increasing trend of the somatosensory component has been observed in group 2 (p = .06). The data suggest that oculomotor exercises, stimulating the extraocular muscle proprioceptors, possibly give somatosensory supplementary cues that positively act on postural stability, while VES, through the spinovestibular pathways, directly facilitates the vestibular nuclei contralateral to the stimulated cervical muscles. Vestibular adaptation exercises and recovery: Acute stage after acoustic neuroma resection.
Doubleblind, placebo controlled trial of rehabilitation for bilateral vestibular hypofunction: Preliminary report. Some proprioceptive influences on the perceptual representation of body shape and orientation.
Improvement of left visuo-spatial hemineglect by left-sided transcutaneous electrical stimulation. Repeated optokinetic stimulation in conditions of active standing facilitates recovery from vestibular deficits.
Short form of the Dizziness Handicap Inventory: Construction and validation through Rasch analysis. The electrical stimulation facilitates the contralateral impaired vestibular nuclei by the crossed spinovestibular pathway, decreasing the duration of total disability and supporting compensation. Because it has been calculated considering the number of negative (no) responses, the score of the questionnaire is inversely related to the handicap. For group 2 patients, we chose oculomotor exercises among those present, in different rehabilitation protocols [2,18-20]. For optokinetic stimulation, patients stood in front of a wall on which were displayed luminous stripes of contrasting colors. In CF Claussen, L Constantinescu, MV Kirtane, D Schneider (eds), Proceedings of the NES , vol 24. The evidence of its central and peripheral action comes from neurophysiological studies [6,7], from demonstration of the soleus H reflex modification produced by transcutaneous vibration of the Achilles tendon [8], and from an improvement of left visuospatial hemineglect in patients suffering from extensive right-hemisphere lesions [9]. Visual and optokinetic stimulations act on the entirety of the structures controlling posture, gaze, and spatial cognition. We invited these patients to stand in an upright orthostatic position without moving the head and to try to maintain balance and to sit only if they felt unable to continue standing. The stripes moved horizontally and vertically at a velocity of 30 degrees per second in both directions. Also, visually guided saccades have been employed in vestibular rehabilitation in determining stabilization of body sway [12,13].
The patients had to stabilize their gaze without following the stripes and while trying to maintain balance.
A comparison of the two groups revealed no statistically significantsignificant difference in all posturography parameters and in the DHI score.
Repeated optokinetic stimulation was found to facilitate recovery from vestibular deficits [14,15]. After the exercises, the patients were invited to walk for the time remaining, as rehabilitation is more effective if the exercises are integrated into such normal activities as walking [21]. Oculomotor exercises, employed in most rehabilitative protocols and including head movements to improve vestibular adaptation, have proved to reduce the perceived overall impairment and postural sway in patients with recent unilateral vestibular disorders, even though the disorders are not associated with head movements. The purpose of this study was to analyze the effects-on static balance and dizziness handicap-of oulomotor rehabilitation (adopting foveal and full-field stimuli) in patients affected by peripheral vestibular lesions and to compare those results with the effects of VES. Comparison of our two study groups did not show any significant difference, revealing that both forms of therapy are effective.



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